THE CANCER CENTER 2014 ANNUAL REPORT CONTAINING 2013 STATISTICS

THE CANCER CENTER 2014 ANNUAL REPORT CONTAINING 2013 STATISTICS

Northside Medical Center Cancer Committee Mission Statement It is the mission of the Cancer Committee to evaluate and monitor the care of cancer patients throughout ValleyCare Northside Medical Center in an effort that will establish, and/or enhance positive outcomes through continuous quality improvement initiatives. Cancer Committee Vision Statement Our vision for tomorrow is seeing the treatment of cancer significantly reduced through preventative lifestyles, more public awareness, free screening programs and new and improved treatment methods, and strive for excellence in meeting the physical, emotional and spiritual needs of our patients and their families. 2

2014 ANNUAL REPORT TABLE OF CONTENTS CONTAINING 2013 STATISTICS Cancer Committee Mission Statement...2 Cancer Committee Vision Statement...2 Acknowledgement...4 Chairman s Report...5 Cancer Committee Members...6 2012 Cancer Conferences Statistics...7 2012 Cancer Conferences...8 ANALYTIC CASES Incidence by Site and Sex...9 Cancer Cases Diagnosed - 2012...10 Patient Outcomes Standard...11 Primary Site Tabulation - 2012... 12-13 Seer Stage and County Codes...14 Age by Sex Graph - 2012...15 Collaborative Group Stage by Sex...16 Treatment...17 Collaborative Group Stage by Sex...18 ANALYTIC LUNG CASES Frequency by Year of Diagnosis...19 Histology...20 AJCC Stage by Sex Graph...21 Seer Stage and County Codes...22 Age by Sex Graph - 2003-2007...23 Five Year Survival by Stage...24 Glossary of Terms...25 3

Northside Medical Center Acknowledgements Our special thanks to the following individuals for their contribution and cooperation in making this publication possible. It would be impossible without them. Kevin Scheetz, MD- Cancer Committee Chairman, ValleyCare Northside Medical Center Karl Wieneke, MD- Cancer Committee Liaison Physician/Vice Chairman, ValleyCare Northside Medical Center Lakshmi S. Perni, MD-Diagnostic Radiology All Cancer Committee Members All Ancillary Cancer Services Administration ValleyCare Medical Center Marketing & Public Relations Cancer Registry Staff Jacqueline Shannon, CTR This publication is produced annually by the Cancer Registry Department in cooperation with ValleyCare Northside Medical Center Marketing & Public Relations Department. For additional copies please call (330) 884-4269. 4

2014 ANNUAL REPORT Northside Medical Center Cancer Committee Chairman s 2014 Annual Report As Chairman of the Cancer Committee, I am happy to report that Valley Care Health System has continued to excel in cancer care management during 2013. Valley Care Health System s cancer program remains accredited by the Commission on Cancer of the American College of Surgeons. Only 25% of hospitals in the United States have cancer programs approved by the Commission on Cancer and 80% of newly diagnosed cancer patients are treated at these institutions. Approval by the Commission on Cancer is only given to those facilities that are voluntarily committed to providing the highest level of quality cancer care and undergo a rigorous evaluation process and review of their performance. The Cancer Registry of Northside Medical Center accessioned 303 analytic cancer cases in 2013. Our hospital system primarily serves a three-county region and over 99% of the new cancer patients reside in this area which includes Mahoning, Trumbull and Columbiana counties. The percentage of female cancer patients registered in 2013 at Northside Medical Center was 61%. This is substantially higher than the national average of 48% female and 52% male cancer patients as reported by the American Cancer Society statistics. There are a few noteworthy differences between state and national statistics and those of Valley Care Health System. Analytic breast cancer cases comprise 23% of our total cancer cases at Northside Medical Center; this is substantially higher than the 14% seen nationwide. This may be due to the highly effective Breast Cancer Program which is one of the busiest programs for screening and diagnostic mammography in the area. Cancer education has also remained a priority at Valley Care Health System. In 2013, our Cancer Committee sponsored our 32 th Annual Cancer Symposium. These cancer symposiums are directed toward physicians and other healthcare professionals and bring presentations by nationally known speakers covering new and emerging concepts in the treatment and diagnosis of cancer. Other educational endeavors include a weekly Tumor Conference, which is a multidisciplinary conference where a number of physicians, including surgeons, medical oncologists, radiation oncologists, pathologists, diagnostic radiologists and primary care physicians discuss the diagnosis and management of specific cases of cancer. We also sponsored a number of educational activities and health screenings for the community including a colorectal cancer screening, lectures for Senior Circle, and a Cancer Caregiver Support group that meets monthly. Kevin L. Scheetz, M.D. Chairman, Cancer Care Committee Western Reserve Care System 5

Northside Medical Center Awards and Distinctions: Commission on Cancer Accreditations with Commendation Northside Medical Center is a Community Cancer Program and has been accredited since 1963. CoC accreditation is a voluntary commitment by a cancer program that ensures its patients will have access to the full scope of services required to diagnose, treat, rehabilitate, and support patients with cancer and their families. Joint Commission Seal of Approval The Joint Commission, the nation s leading health care standards-setting and accrediting organization, accredits hospitals as well as nursing homes and other health care organizations. Specially trained investigators assess whether these organizations meet set standards. Patients are seen in the Medical Imaging Department through physician referral, on an inpatient, outpatient and emergent care basis. Our Imaging Service Practice Guidelines follow the standards and recommendations set forth (but not limited to) the following: American College of Radiology Ranked Among the Top 10% in the Nation for GI Services for 2 Years in a Row (2012-2013) Ranked Among the Top 10 in Ohio for GI Services for 2 Years in a Row (2012-2013) Ranked Among the Top 10 In Ohio for GI Medical Treatment for 2 Years in a Row (2012-2013)

2014 ANNUAL REPORT NORTHSIDE MEDICAL CENTER 2013 CANCER COMMITTEE MEMBERS Medical Staff Kevin Scheetz, MD- Chairman, Pathology Karl Wieneke, MD- Vice-Chairman, Liaison, Physician Richard Barr, MD- Diagnostic Radiology Peter De Vito, MD-General Surgery Daniel Ebert, MD-Surgery Arthur Greenbaum, MD-Radiation Oncology Chris Knight, MD-Hematology Oncology The Hope Center Robert Marx, DO-General Sugery Eugene Tareshawty, MD-Hospice, Pain Management- The Hope Center Ancillary Staff Allyn Booher, RPh- Oncology Pharmacy Deborah Gilbert, LD, RD- Oncology Nutrition Darla Habosky, AAS, RT June Koning, RN, OCN Mary Ann Hall, RN- Quality Management Alisa Mahan, MA- American Cancer Society Mary Morris, BA, LSW, MSEd- Oncology Social Worker Sandy Massulo, RT Jacqueline Shannon, CTR- Cancer Registry Linda Steckelmeyer, RN Debbie Yurchison, OTR/L Cancer Conference Fellows Internal Medicine Residents Surgery Residents 6

CANCER SERVICES RADIATION THERAPY SCOPE OF SERVICE: The Radiation Oncology Department is a facility dedicated to the treatment of cancer patients, employing linear accelerator, for therapeutic intervention. Treatments and care are delivered to patients with varying stages of morbidity. The radiation department is staffed by two radiation physicians who work with a physicist, dosimetrits and radiation therapists. HOURS: Regular hours of operation are 7:00 a.m. to 3:30 p.m., Monday through Friday. Emergency services are available at all other times. LOCATION: Northside Medical Center Radiation Oncology Department Medical Office Building B 500 Gypsy Lane Youngstown, Ohio 44501 CENTER FOR BREAST HEALTH: Northside Medical Center offers screening and diagnostic breast imaging technology, including digital mammography, breast MRI and stereotactic biopsy. Our technologists utilize the imaging technology to help detect cancer at the earliest stages and provide a full spectrum of care. IMAGING AND RADIOLOGY: From angiography and X-rays to complex endoscopic procedures and digital mammography, we offer a full spectrum of imaging services delivered by caring, knowledgeable technologists. We offer leading-edge technology to provide the latest in diagnostic and therapeutic techniques, including: Biopsy Bone densitometry Breast imaging CT Scan Echocardiogram Fluoroscopy Interventional radiology MRI Nuclear medicine PET/CT Scan Ultrasound X-ray 7

2014 ANNUAL REPORT 2013 CANCER CONFERENCES SITE PROSPECTIVE RETROPECTIVE ABDOMEN 1 0 ANUS 2 0 BLADDER 2 0 BONE MARROW 1 0 BREAST 17 0 CECUM 2 0 CERVIX 1 0 CHEST WALL 1 0 COLON 11 0 COMMON BILE DUCT 1 0 ESOPHAGUS 1 0 GE JUNCTION 2 0 KIDNEY 3 0 LUNG 20 0 LYMPHOMA 2 0 MALE BREAST 1 0 MELANOMA 4 0 MESOTHELIOMA 1 0 OVARY 1 0 PELVIC MASS 1 0 PROSTATE 1 0 RECTOSIGMOID 1 0 RECTUM 4 0 RETROPERITONEUM 1 0 SKIN 0 2 SOFT TISSUE 1 0 STOMACH 4 0 TESTIS 1 0 THYROID 2 0 TONSIL 1 0 UTERUS 2 0 TOTAL 93 2 PERCENT 98% 2% 8

AGE BY SEX GRAPH 2013-ANALYTIC-CASES Age Range Male Female 10-19 0 1 20-29 2 4 30-39 4 4 40-49 1 13 50-59 15 31 60-69 27 41 70-79 40 51 80-89 20 34 90-99 9 6 TOTALS 118 185 9

2014 ANNUAL REPORT COMMUNITY OUTREACH A Cancer Caregiver Support Group meets in the Radiation/Oncology Department waiting room at Northside Medical Center on the second Tuesday of each month. This group is open to the community. The support group was promoted through the hospital s Community Calendar, which is posted on the hospital website as well as released to the local media. A community colorectal screening event was held in March of 2013. The event was promoted in the Health Connections community newsletter and in newsprint advertising. Local press was notified via media release. Event flyers were distributed in physician offices and throughout the community. Approximately 200 kits were distributed. Two patient results were positive. One patient was uninsured and did not return and the other patient did not follow up with his PCP. Colorectal Cancer was the topic for a Senior Circle Lunch N Learn programs presented by William Lee, M.D. on March 12. 2013. The lecture informed and educated attendees about colon cancer, the importance of screenings, recognizing symptoms and preventive measures. Free colorectal cancer screening kits were distributed. Senior Day, a free community event sponsored by Northside Medical Center, was held August 22, 2013 at the Southern Park Mall where an estimated 1,000 seniors age 50 and older attended and approximately 377 took advantage of free health screenings. The Center for Breast Health was one of 12 services of Northside Medical Center promoted at the event. Information was available on breast cancer, breast health, and mammography. Colorectal screening kits were also distributed to over 200 participants Senior Circle, NMC was a co-sponsor and also hosted a private luncheon for seniors on August 24, 2013 to support the American Cancer Society of the Mahoning Valley s celebration to honor the ACS's 100 years of birthdays. The "Finish the Fight Festival" NMC, Senior Circle luncheon featured cancer research keynote speaker - Dr. Gary Koski, American Cancer Society Researcher with Kent State University. Dr. Koski gave a private presentation during the luncheon on the insight on cancer research to 55 Senior Circle members and community members who were attending the Finish the Fight Festival. "Bumps and Lumps... and what you need to know" was the title of the October 10, 2013 NMC, Senior Circle - Dine with the Doctor event featuring keynote speaker Dr. James Smith, MD. Dr. Smith spoke about the strange lumps and scary bumps that you might find on your body. He provided education on when lumps and bumps could be cancerous and when you need to seek medical attention. Linda Sticklemyer from the Center of Breast Health was invited to attend the event and represent the NMC Center for Breast Health with a table providing information on breast health. 10

AGE BY SEX 2013-ANALYTIC-CASES Age Range Male Female 10-19 0 1 20-29 2 4 30-39 4 4 40-49 1 13 50-59 15 31 60-69 27 41 70-79 40 51 80-89 20 34 90-99 9 6 TOTALS 118 185 GENERAL STAGE BY SEX 2013-ANALYTIC-CASES Stage Male Female 0 15 18 1 39 80 2 3 9 3 14 16 4 5 9 5 3 2 7 31 40 8 6 5 9 2 6 TOTALS 118 185 AJCC STAGE BY SEX 2013-ANALYTIC-CASES Stage Male Female 0 14 18 I 25 43 II 19 45 III 18 22 IV 30 39 UNK 3 6 N/A 9 12 TOTALS 118 185 11

2014 ANNUAL REPORT COUNTY CODES 2013-ANALYTIC-CASES COUNTY NUMBER PERCENT COLUMBIANA 12 4 MAHONING 214 70.6 TRUMBULL 75 24.8 ANY OTHERS 2 0.7 TOTALS 303 100% 250 200 150 100 50 COLUMBIANA MAHONING PORTAGE TRUMBULL ANY OTHERS 0 12

The majority of cancer cases were diagnosed in patients who were between 40-years-of-age and 89-years-of age as seen below. AGE AT DIAGNOSIS 2008-2013 AGE 2008 2009 2010 2011 2012 2013 0-29 8 3 2 4 6 7 30-39 17 5 5 5 3 8 40-49 39 29 21 23 10 14 50-59 95 67 50 56 46 46 60-69 93 98 93 78 83 68 70-79 137 115 106 99 85 91 80-89 103 87 99 66 71 54 90+ 3 3 5 6 3 15 AJCC CANCER STAGE AT DIAGNOSIS 2008-2013 AJCC 2008 2009 2010 2011 2012 2013 0 22 10 24 23 20 18 0A 7 6 10 11 8 14 1 79 57 64 53 35 34 1A 14 5 13 23 30 33 1B 15 5 11 12 7 6 2 19 10 15 4 7 16 2A 52 34 26 26 31 37 2B 16 18 16 15 23 10 3 10 7 5 7 6 2 3A 14 16 16 16 17 9 3B 20 18 16 16 16 17 3C 0 0 0 0 0 1 4 70 86 66 54 54 57 4A 6 8 4 6 3 3 4B 2 3 6 4 4 7 88 45 36 44 18 14 21 99 97 85 50 46 25 13 OTHER 14 7 6 10 13 5 13

2014 ANNUAL REPORT SEER STAGE FOR 2013 NUMBER PERCENT IN SITU 33 10.9 LOCALIZED 119 39.3 REGIONAL 61 20.1 DISTANT 71 23.4 UNKOWN 8 2.6 ANY OTHERS 11 3.6 TOTALS 314 100 CONTROLLING VARIABLES IN SITU is GENERAL STAGE 0 LOCALIZED is GENERAL STAGE 1 REGIONAL is GENERAL STAGE 2,3,4,5 DISTANT is GENERAL STAGE 7 UNKOWN is GENERAL STAGE 9 TOP FIVE SITES AJJC STAGE FOR 2013 SITE STG 0 STG 1 STG 2 STG 3 STG 4 OCCULT UNK TOTAL LUNG 0 6 5 21 34 6 7 79 BREAST 13 22 19 8 4 0 7 73 COLON 1 10 12 6 3 0 5 37 BLADDER 0 1 3 1 1 0 8 14 ESOPHAGUS 1 0 5 1 3 0 1 11 14

SITE TABULATION 2013 ANALYTIC CASES SITE NAME CASES PERCENT MALE PERCENT FEMALE PERCENT BASE OF TONGUE 1 0.33 1 100 0 0 TONSIL 2 0.66 1 50 1 50 PYRIFORM SINUS 1 0.33 0 0 1 100 ESOPHAGUS 3 0.99 2 66.67 1 33.33 STOMACH 10 3.3 5 50 5 50 COLON 34 11.22 10 29.41 24 70.59 RECTOSIGMOID JUNCTION 5 1.65 4 80 1 20 RECTUM 12 3.96 4 33.33 8 66.67 ANUS & ANAL CANAL 5 1.65 2 40 3 60 LIVER & BILE DUCTS 4 1.32 2 50 2 50 PANCREAS 6 1.98 2 33.33 4 66.67 LARYNX 1 0.33 1 100 0 0 TRACHEA 1 0.33 1 100 0 0 BRONCHUS & LUNG 58 19.14 30 51.72 28 48.28 HEART MEDIASTINUM PLEURA 1 0.33 1 100 0 0 BONES JOINTS & OTHER UNSPECIFIED SITES 1 0.33 0 0 1 100 BLOOD & BONE MARROW 2 0.66 0 0 2 100 SKIN 2 0.66 1 50 1 50 RETROPERITONEUM & PERITONEUM 1 0.33 1 100 0 0 CONNECTIVE SUBCUTANEOUS OTHER SOFT TISSUE 1 0.33 1 100 0 0 BREAST 70 23.1 1 1.43 69 98.57 CERVIX UTERI 2 0.66 0 0 2 100 CORPUS UTERI 9 2.97 0 0 9 100 OVARY 1 0.33 0 0 1 100 PROSTATE GLAND 7 2.31 7 100 0 0 TESTIS 1 0.33 1 100 0 0 KIDNEY 4 1.32 2 50 2 50 URETER 1 0.33 1 100 0 0 URINARY BLADDER 27 8.91 23 85.19 4 14.81 OTHER & UNSPECIFIED URINARY ORGANS 2 0.66 1 50 1 50 MENINGES 1 0.33 1 100 0 0 BRAIN 1 0.33 0 0 1 100 THYROID GLAND 5 1.65 0 0 5 100 OTHER ILL DEFINED SITES 2 0.66 1 50 1 50 LYMPH NODES 7 2.31 5 71.43 2 28.57 UNK PRIMARY 12 3.96 6 50 6 50 TOTAL CASES 303 100 118 38.94 185 61.06 15

2014 ANNUAL REPORT 2013 ANALYTIC CASES TNM STAGE GRP CASES PERCENT 0 32 10.56% I 68 22.44% II 64 21.12% III 40 13.20% IV 69 22.77% UNK 9 2.97% N/A 21 7% TOTAL CASES 303 100.00% 16

2014 IN-DEPTH REPORT ON BREAST CANCER The cancers that most often affect women are breast, colorectal, endometrial, lung, cervical, skin, and ovarian cancers. Breast cancer is the most common that women may face. It can occur at any age, but most likely to occur after the age of 40, and the risk goes up as you age. An estimated 232,340 new cases of invasive breast cancer were expected among US women, as well as an estimated 64,640 additional cases of in situ breast cancer. This is quoted from the American Cancer Society Breast Facts & Figures. At ValleyCare Northside Medical Center 70 patients were diagnosis with breast cancer for 2013. This included 69 women and one male patient. Analysis of the ValleyCare Northside Medical Center Experience Histology The distribution of sites in breast cancer for 2013 at ValleyCare Northside Medical Center was; cancer, NOS (not otherwise specified) 1 total at various sites of the breast; adenocarcinoma, NOS-2; tubular adenocacarinoma-1; apocrine adenocarcinoma-1; intraductal carcinoma noninfiltrating, NOS-13; infiltrating ductal carcinoma-44; lobular carcinoma, NOS-5; Infiltrating ductal and lobular carcinoma-1; infiltrating duct mixed with other types of carcinoma-2. These occurred at different areas of the breast with the most in the upper outer quadrant of the breast. Race and gender For 2013 there were a total of 70 breast cases, 1 case of a Caucasian male, 49 cases of Caucasians females. A total of 19 African American female and 1 patients reported as unknown race. There were no cases found with Native Americans or Asian or Oriental patients or patients of Hispanics decent. Age at diagnosis There were 11 female patients (15.7%) found with breast cancer under the age of 50, 51-70 there were 30 females (40%) and 1 male (4.3%) found with breast cancer. 70-94 there were 28 female patients (40%) found with breast cancer. County of residence There were 55 patients (78.6%) from Mahoning County, 11 patients (15.7%) from Trumbull County, 2 patients (2.9%) from Columbiana County and 2 patients (2.9%) from other counties that were diagnosed and or treated at ValleyCare Northside Medical Center. 17

2014 ANNUAL REPORT 2014 IN-DEPTH REPORT ON BREAST CANCER (cont.) Stage at Diagnosis There were 13 cases of stage 0 or In Situ breast carcinomas (19%), 36 (51%) patients were diagnosed as Localized breast cancer, 13 patients as regional diagnosis (19%), 7 patients diagnosed with Distant or Metastatic disease (10%). This is by SEER General Staging. Staging by AJCC, Stage 0 13 (19%), Stage I-15 patients (21%), Stage II 25 patients (36%), Stage III 8 patients (11%), Stage IV 7 patients (10%) and 2 patients were staged as unknowns (3%). Five Year Relative Survival The fiver year survival of all breast cases at ValleyCare Northside Medical Center was 72.76% (533 cases). The most recent data for national relative survival rates for women diagnosed with breast cancer are: 89% at five years after diagnosis, 83% after 10 years and 78% after 15 years. Summary The 5 Year relative survival rate for NMC is slightly better than the National survival trends throughout the United States. 72.6% VS 89%. There 5 year survival rate is general and not by staging, race or age. 8 patients in 2013 were age 40-49 which is 6% of cases. 51% localized disease which were Stage 1 and 2. 19% of cases were Ductal Carcinoma in Situ- Stage 0 Stage 3-11% Stage 4-10% 63% of Breast cancers were infiltrating ductal, followed by intraductal cancer. The majority of breast lumpectomies receive the standard of Radiation therapy. Mammography is still the effective method of early detection. As long as a woman is in good health she should continue Mammography and if needed she would be able to withstand treatment. Tumor Board continues to provide Multidisciplinary approach to the complex diagnosis of Breast Cancer Care. Lakshmi Perni, MD Diagnostic Radiology ValleyCare Northside Medical Center 18

SITE OF CANCER AT TIME OF DIAGNOSIS, 2013 TOPOGRAPHY CODE #CASES PERCENT C50.0, Nipple 0 0 C50.1, Centeral Portion of Breast 0 0 C50.2, Upper Inner Quadrant 6 8.6 C50.3, Lower Inner Quadrant 3 4.3 C50.4, Upper Outer Quadrant 16 22.9 C50.5, Lower Outer Quadrant 3 4.3 C50.6, Axillary Tail 0 0 C50.8, Overlapping Quadrant 24 34.3 C50.9, Breast, NOS 18 25.7 TOTAL 70 100% SITE OF CANCER AT TIME OF DIAGNOSIS, 2008-2013 TOPOGRAPHY CODE # CASES PERCENT C50.0, Nipple 11 2.1 C50.1, Central Portion of Breast 26 4.9 C50.2, Upper Inner Quadrant 51 9.6 C50.3, Lower Inner Quadrant 17 3.2 C50.4, Upper Outer Quadrant 159 29.8 C50.5, Lower Inner Quadrant 22 4.1 C50.6, Axillary Tail 2 0.4 C50.8, Overlapping Quadrant 121 22.7 C50.9, Breast, NOS 124 23.3 TOTAL 533 100% 19

2014 ANNUAL REPORT BREAST CASSES BY SEX AND RACE, 2013 RACE MALE FEMALE TOTAL PERCENT WHITE 1 49 50 71.4 BLACK 0 19 19 27.1 OTHER ASIAN 0 0 0 0 UNKNOWN 0 1 1 1.4 TOTAL 1 69 70 100 RACE MALE FEMALE TOTAL PERCENT WHITE 5 403 408 76.5 BLACK 1 121 122 22.9 OTHER ASIAN 0 2 2 0.4 UNKNOWN 0 1 1 0.2 TOTAL 6 527 533 100 20

2013 AGE BY SEX Age Range Male Female 20-29 0 1 30-39 0 1 40-49 0 8 50-59 0 16 60-69 1 15 70-79 0 17 80-89 0 10 90-99 0 1 TOTALS 1 69 21

2014 ANNUAL REPORT AGE AT DIAGNOSIS MALE FEMALE TOTAL PERCENT 27 0 1 1 0.2 28 0 1 1 0.2 34 0 1 1 0.2 35 0 1 1 0.2 36 0 1 1 0.2 37 0 3 3 0.6 38 0 2 2 0.4 39 0 3 3 0.6 40 0 3 3 0.6 41 0 5 5 0.9 42 0 6 6 1.1 43 0 3 3 0.6 44 0 4 4 0.8 45 0 7 7 1.3 46 0 3 3 0.6 47 1 10 11 2.1 48 0 9 9 1.7 49 0 6 6 1.1 50 0 9 9 1.7 51 0 11 11 2.1 52 0 11 11 2.1 53 0 13 13 2.4 54 0 15 15 2.8 55 0 10 10 1.9 56 0 9 9 1.7 57 0 7 7 1.3 58 0 9 9 1.7 59 0 17 17 3.2 60 0 14 14 2.6 61 0 13 13 2.4 62 0 8 8 1.5 63 0 11 11 2.1 64 1 12 13 2.4 65 0 22 22 4.1 66 1 11 12 2.3 67 1 9 10 1.9 68 0 8 8 1.5 69 0 10 10 1.9 70 0 12 12 2.3 22

AGE AT DIAGNOSIS MALE FEMALE TOTAL PERCENT 71 0 12 12 2.3 72 0 16 16 3 73 0 9 9 1.7 74 1 9 10 1.9 75 0 11 11 2.1 76 0 13 13 2.4 77 0 20 20 3.8 78 0 14 14 2.6 79 0 17 17 3.2 80 0 11 11 2.1 81 0 16 16 3 82 0 8 8 1.5 83 1 14 15 2.8 84 0 6 6 1.1 85 0 9 9 1.7 86 0 5 5 0.9 87 0 6 6 1.1 88 0 6 6 1.1 89 0 3 3 0.6 90 0 4 4 0.8 92 0 2 2 0.4 93 0 1 1 0.2 94 0 3 3 0.6 95 0 2 2 0.4 TOTAL 6 527 533 100% 23

2014 ANNUAL REPORT ZIP CODE TOTAL VALUES NBR (%) 44401 1 1.4 44405 2 2.7 44406 5 6.8 44408 2 2.7 44420 6 8.2 44425 4 5.5 44436 2 2.7 44440 3 4.1 44442 1 1.4 44451 2 2.7 44471 1 1.4 44473 2 2.7 44481 2 2.7 44483 1 1.4 44502 3 4.1 44504 2 2.7 44505 5 6.8 44507 1 1.4 44509 1 1.4 44510 3 4.1 44511 6 8.2 44512 5 6.8 44514 2 2.7 44515 11 15.1 TOTALS 73 100% 24

2013 ANALYTIC BREAST CASES BY COUNTY CODE COUNTY # CASES PERCENT COLUMBIANA 2 2.9 GEAUGA 0 0 MAHONING 55 78.6 PORTAGE 0 0 SUMMIT 0 0 TRUMBULL 11 15.7 ANY OTHERS 2 2.9 TOTAL 70 100% 2008-2013 ANAYLTIC BREAST CASES BY COUNTY AT DIAGNOSIS COUNTY # CASES PERCENT COLUMBIANA 16 3 GEAUGA 0 0 MAHONING 384 72 PORTAGE 1 0.2 SUMMIT 1 0.2 TRUMBULL 124 23.3 ANY OTHERS 7 1.3 TOTALS 533 100% 25

2014 ANNUAL REPORT SEER STAGE 2013 BREAST CASES SEER STAGE DESCRIPTION # CASES PERCENT 0 IN SITU 13 18.6 1 LOCALIZED 36 51.4 2,3,4,5 REGIONAL 13 18.6 7 DISTANT 7 10 9 UNKOWN 1 1.4 TOTAL 70 100% SEER SUMMARY OF STAGE 2008-2013 BREAST CASES SEER STAGE DESCRIPTION # CASES PERCENT 0 IN SITU 88 16.5 1 LOCALIZED 238 44.7 2,3,4,5 REGIONAL 125 23.5 7 DISTANT 23 4.3 9 UNKOWN 59 11.1 TOTAL 533 100 26

HISTOLOGY AT DIAGNOSIS, 2013 HISTOLOGY #CASES PERCENT 8010/3 Carcinoma NOS 1 1.4 8140/3 Adenocarcinoma NOS 2 2.9 8211/3 Tubular adenocarcinoma 1 1.4 8401/3 Apocrine adenocarcinoma 1 1.4 8500/2 Intraductal carcinoma noninfiltrating NOS 13 18.6 8500/3 Infiltrating duct carcinoma 44 62.9 8520/3 Lobular carcinoma NOS 5 7.1 8522/3 Infiltrating duct and lobular carcinoma 1 1.4 8523/3 Infiltrating duct mixed with other types of carcinoma 2 2.9 Total 70 100% HISTOLOGY AT DIAGNOSIS, 2008-2013 HISTOLOGY #CASES PERCENT 8010/3 Carcinoma NOS 4 0.8 8050/3 Papillary carcinoma NOS 2 0.4 8140/3 Adenocarcinoma NOS 4 0.8 8201/2 Cribriform carcinoma in situ 1 0.2 82211/3 Tubular adenocarcinoma 1 0.2 8401/3 Apocrine adenocarcinoma 3 0.6 8480/3 Mucinous adenocarcinoma 6 1.1 8500/2 Intraductal carcinoma noninfiltrating NOS 69 12.9 8500/3 Infiltrating duct carcinoma 325 61 8501/2 Comedocarcinoma noninfiltrating 2 0.4 8503/2 Noninfiltrating intraductal papillary adenocarcinoma 3 0.6 8504/2 Noninfiltrating intracystic carcinoma 2 0.4 8501/3 Intracystic carcinoma NOS 2 0.4 7407/2 Intraductal micropapillary carcinoma 4 0.8 8510/3 Medullary carcinoma NOS 2 0.4 8520/2 Lobular carcinoma in situ 3 0.6 8520/3 Lobular carcinoma NOS 40 7.5 8522/2 Intraductal carcinoma and lobular carcinoma in situ 1 0.2 8522/3 Infiltrating duct and lobular carcinoma 23 4.3 8523/2 Intraductal carcinoma mixed with other types 2 0.4 8523/3 Infiltrating duct mixed with other types of carcinoma 22 4.1 8524/3 Infiltrating lobular mixed with other types of carcinoma 2 0.4 8530/3 Inflammatory carcinoma 2 0.4 8541/3 Paget's disease and infiltrating duct carcinoma of breast 2 0.4 8543/3 Paget's with DCIS 1 0.2 8575/3 Metaplastic carcinoma, NOS 3 0.6 8020/3 Phyllodes tumor malignant 2 0.4 Total 533 100% 27

2014 ANNUAL REPORT FIRST COURSE OF TREATMENT, 2013 TYPE OF TREATMENT # CASES PERCENT SURG 16 22.86% BIOPSY 15 21.43% SURG/RAD/HOR 8 11.43% SURG/CHEM 5 7.14% SURG/CHEM/RAD 5 7.14% SURG/HOR 4 5.71% RAD 3 0.04285714 SURG/RAD 3 4.29% CHEM 3 4.29% HOR 2 0.02857143 SURG/CHEM/RAD/IMMU 2 0.02857143 SURG/CHEM/RAD/HOR 2 0.02857143 SURG/CHEM/HOR 1 0.01428571 SURG/CHEM/RAD/HOR/IMMU 1 0.01428571 TOTAL CASES 70 100.00% FIRST COURSE OF TREATMENT, 2008-2013 TYPE OF TREATMENT # CASES PERCENT BIOPSY 113 21.20% SURG 111 20.83% SURG/RAD/HOR 76 14.26% SURG/CHEM/RAD 46 8.63% SURG/HOR 41 7.69% SURG/CHEM/RAD/HOR 30 5.63% SURG/RAD 27 0.05065666 SURG/CHEM 25 4.69% SURG/CHEM/HOR 16 3.00% SURG/CHEM/RAD/HOR/IMMU 9 0.01688555 SURG/CHEM/RAD/IMMU 7 0.01313321 HOR 7 0.01313321 SURG/CHEM/IMMU 6 0.01125704 RAD 3 0.00562852 CHEM 3 0.56% CHEM/RAD/HOR 3 0.56% CHEM/HOR 2 0.00375235 RAD/HOR 2 0.00375235 SURG/CHEM/HOR/IMMU 1 0.00187617 CHEM/HOR/IMMU 1 0.00187617 SURG/RAD/IMMU 1 0.00187617 SURG/HOR/IMMU 1 0.00187617 CHEM/IMMU 1 0.00187617 CHEM/RAD 1 0.00187617 TOTAL CASES 533 100.00% 28

RELATIVE SURVIVAL ANALYSIS 01-2008-2013-BREAST-CASES BEGIN % 100 YEAR 1 97.4 YEAR 2 92.4 YEAR 3 85.7 YEAR 4 80.9 YEAR 5 73.7 29

2014 ANNUAL REPORT GLOSSARY OF TERMS CLASS OF CASE Analytic- Patients who were diagnosed and/or treated as part of their first course of treatment at Northside Medical Center. These are Class of Case 00 through 22. Non-Analytic- Patients diagnosed previously and now with recurrence, patients diagnosed at our facility prior to our reference year (2006) and cancers diagnosed at autopsy. These cases are not included in survival statistics. These are Class of Cases 30 through 38. FIRST COURSE OF TREATMENT The initial cancer-directed treatment or series of treatments, usually initiated within four months of the date of diagnosis. PRIMARY SITE The anatomical location within the human body considered to the point of origin of the malignancy. STAGE OF DISEASE The extent of the cancer spread as determined at the time of first evaluation. In-situ The tumor meets all criteria for malignancy except invasion. Local The tumor is confined to the organ of origin. Regional The tumor has spread by direct extension to adjacent organs and/or has metastasized to regional lymph nodes. Distant The tumor has spread beyond the immediate adjacent organ by direct extension: has developed secondary or metastatic tumors: has metastasized to distant lymph nodes; or has been determined to be systemic in origin. Unknown/Unspecified/Not Applicable There is no AJCC staging available, or cannot be determined from the medical record or medical authority. PROTOCOL GROUPS Local & Institutional Trials REFERENCES American Cancer Society: Cancer Facts & Figures 2012 AJCC Cancer Staging Manuel, Seventh Edition ICD-O, Third Edition International Classification of Disease for Oncology SEER Summary Staging Manual, Revised 2010 Fords Manual Revised 2012 Collaborative Staging-CSv2.04 28

Northside Medical Center Cancer Registry Medical Office Building B 500 Gypsy Lane Youngstown, Ohio 44501 Phone: (330) 884-4269 www.valleycareofohio.net